DWC 9783 Notice of Predesignation of Personal Physician

Last UpdatedNovember 4, 2015
Total Files3
Version07/2014

California employees have the right to designate a personal physician outside the employer's MPN whom they wish to be treated by in the event of an injury, as long as the employee provides written notice of their personal physician. This is an optional form employers may provide to employees wishing to predesignate a physician, if the employer does not develop their own form.

Information about worker's compensation regulations regarding predesignation of personal physicians is available on the CA Dept. of Industrial Relations website.

 


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DWC 9783 Notice of Predesignation of Personal Physician (CA).pdf
DWC 9783 DESIGNACIÓN PREVIA DE MÉDICO PERSONAL
Link to CA Division of Workers' Compensation forms directory
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